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. 2022 Sep 23:9:1026952.
doi: 10.3389/fsurg.2022.1026952. eCollection 2022.

Unilateral biportal endoscopic lumbar interbody fusion assisted by intraoperative O-arm total navigation for lumbar degenerative disease: A retrospective study

Xinle Huang  1 , Junfeng Gong  1 , Huan Liu  1 , Zegang Shi  1 , Wenkai Wang  1 , Shuai Chen  1 , Xiaobing Shi  1 , Changqing Li  1 , Yu Tang  1 , Yue Zhou  1
Affiliations

Unilateral biportal endoscopic lumbar interbody fusion assisted by intraoperative O-arm total navigation for lumbar degenerative disease: A retrospective study

Xinle Huang et al. Front Surg. .

Abstract

Background: Recently, unilateral biportal endoscopic lumbar interbody fusion (BE-LIF) has been successfully applied for degenerative diseases of the lumbar spine, with good clinical results reported. However, the drawbacks include radiation exposure, limited field of view, and steep learning curves.

Objective: This retrospective study aimed to compare the results between navigation and non-navigation groups and explore the benefits of BE-LIF assisted by intraoperative O-arm total navigation.

Methods: A total of 44 patients were retrospectively analyzed from August 2020 to June 2021. Perioperative data were collected, including operative time, estimated intraoperative blood loss, postoperative drainage, postoperative hospital stay, radiation dose, and duration of radiation exposure. In addition, clinical outcomes were evaluated using postoperative data, such as the Oswestry Disability Index (ODI), visual analog scale (VAS), modified MacNab criteria, Postoperative complications and fusion rate.

Results: The non-navigation and navigation groups included 23 and 21 patients, respectively. All the patients were followed up for at least 12 months. No significant differences were noted in the estimated intraoperative blood loss, postoperative drainage, postoperative hospital stay, fusion rate, or perioperative complications between the two groups. The radiation dose was significantly lower in the navigation group than in the non-navigation group. The average total operation time in the navigation group was lower than that in the non-navigation group (P < 0.01). All clinical outcomes showed improvement at different time points postoperatively, with no significant difference noted between the two groups (P > 0.05).

Conclusions: Compared with the non-navigation approach, O-arm total navigation assistive BE-LIF technology not only has similar clinical results, but also can provide accurate intraoperative guidance and help spinal surgeons achieve accurate decompression. Furthermore, it can reduce radiation exposure to surgeons and operation time, which improve the efficiency and safety of surgery.

Keywords: intraoperative o-arm; lumbar degenerative diseases; minimally invasive spine; total navigation; unilateral biportal endoscopic lumbar interbody fusion.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A,B) The navigation reference frame is fixed to the posterior superior iliac spine. (C) The O-arm device is placed and prepared for image capture.
Figure 2
Figure 2
Design of intraoperative skin incision assisted by navigation.
Figure 3
Figure 3
Extent of intraoperative decompression can be confirmed in real time on the navigation screen. (A) cranial, (B) caudal, (C) ipsilateral, and (D) contralateral decompression range detection probes.
Figure 4
Figure 4
(A,B) Intervertebral space is processed with reamers of different diameters, whose angles and orientations can be displayed in real time on a computer screen. (C,D) A serial trial under navigation guidance was used to determine the height of the disc and true size of the CAGE.
Figure 5
Figure 5
(A) Intervertebral bone grafting was performed using a specialized funnel. (B,C) The PEEK CAGE can be safely inserted into the intervertebral space with the size, orientation, and depth displayed on the navigation screen.
Figure 6
Figure 6
Track of the access tracker was visible in real time, and spine surgeons could adjust the needle entry point based on the trajectory and position image of the screw displayed in real time on the navigation screen.
See this image and copyright information in PMC

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